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F PRI- c CITY OF PRIOR LAKE BUILDING PERMIT, 0---/Date Rec'db
° TEMPORARYAND CERTIFICATEUTILITYCONNECTION OF ZONINGPERMIT COMPLIANCE
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4'MNEse I. white File z
2 Pink City PERMIT NO/'' ,...1 O
3 Yellow Applicant /
(Please type or print and sign at bottom)
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ADDRESS ZONING(office use)
et q 11 04014'el IA\-C.d '--bikli`e../
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER � '
aL y4I AU-)
(Phone)
(Address) 11 (M. i ' !'k-- ii\-C-1 , f?iiv L �4, Oil lid
BUILDER ) l / / i 1 ?/Q 6 13 c
(Company Name) IL J L,/e•5 'Q (Phone) �j _ /, /
(Contact Name)r 1^. ✓ (Ph/one) L,1.:) )71-"7 l 4
(Address) I`1 � z4 4I' --�r� t/'!� /'/"V Cs-21 Ly
TYPE OF WORK 0 New Construction ❑Deck DPorch -Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
['Addition ['Alteration ['Utility Co ction
CODE: a 1.R.C. DI.B.C. 0 Misc.
Type of Cot3struction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have hirnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned prope,- and that al onstr tenon will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
,kofficial can revoke . permit for) . cause in ennore,I hereby agree that the city official or a designee may enter uponAhe property to perform needed i +pest ons.
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Signature Contractor's License No. Date
Permit Valuation 7%1 F . — Park Support Fee # $
Permit Fee $ .-1 4.7c SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ S - Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ --7q -7
This A icaption Becomes Youi'iBuilding Permit Wh Ap oved Paid 7 7 Recei t o. n c g )
t, Date4,,
By ` i
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41111.1.—
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` _ ate
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions,if any
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24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372